All healthcare assistants should complete a certificate in “fundamental” care before they can look after patients unsupervised, a government commissioned review has recommended.
Introducing the Certificate of Fundamental Care would help drive up standards and improve the status of support workers, according to the independent review into support worker training and support.
The review, which was carried out by the Sunday Times journalist Camilla Cavendish, said HCAs who completed the certificate should be allowed to use the term “nursing assistant” in a bid to reduce the number of current job titles held by support workers.
It said the “profusion of job titles” for support workers in health and social care must be reduced to improve public understanding of the different nursing roles.
During her research for the review, Ms Cavendish found 60 different job titles to describe similar roles across health and social care.
She found HCAs in many places were carrying out procedures such as cannulation, giving injections, female catherisation and applying complex dressings
Ms Cavendish said the description of the work of HCAs as “basic care” understated the skill needed for many of the tasks and proposed the Certificate of Fundamental Care would be a “badge of honour” and “a first step in a caring career”.
“I have come away from this project thinking that our society is incredibly lucky to have so many people with a dedication to caring,” she wrote.
“But I also fear that if we continue to take them for granted, if we do not fix dysfunctional systems of commissioning and regulation, we may find as we grow old that they are not there to look after us.”
Ms Cavendish proposed the certificate be the same across health and social care, allowing the development of a “shared set of language and values”, while a higher certificate or certificates should also be introduced to allow more opportunity for career progression.
She called for the Care Quality Commission to require support workers in all settings to have achieved the certificate before they can work unsupervised.
Ms Cavendish, who has written extensively about health, was asked to examine the role of HCAs and social care support workers in the wake of the Francis report into care failings at Mid Staffordshire Foundation Trust.
Ms Cavendish also recommends that directors of nursing take back responsibility for the HCA workforce from human resources departments.
She echoed proposals announced by Health Education England recently to make it easier for HCAs to progress into nursing by recognising caring experience.
However, she noted many HCAs had no ambition to become nurses, after seeing how much time they spend on paperwork.
The review’s terms of reference did not include the heavily debated issue of mandatory regulation for HCAs, which led to unions criticising the review when it was initially announced.
Royal College of Nursing chief executive and general secretary Peter Carter welcomed proposals for the certificate and “moves to bring the professions closer”.
However, he warned without statutory regulation of support workers, there was nothing to stop “unsuitable” HCAs from moving between providers.
Unison head of health Christine McAnea described the review as a “once in a generation” opportunity to make changes and called on the government to commit to properly fund training for HCAs.
The government will respond fully to the review when it publishes its full response to the Francis report later this year.
The Nursing and Midwifery Council said it welcomed the report’s “emphasis on the valuable” work HCAs do.
“In the interests of public protection, the NMC welcomes the proposal for a mandatory certificate of fundamental care and a requirement that all HCAs have this to work with patients.
“It will assist nurses in assuring themselves that they are delegating appropriately,” an NMC spokeswoman said.
Crystal Oldman, chief executive of the Queen’s Nursing Institute, said: “A certificate of fundamental care would provide a minimum agreed level of education and training and would arguably be beneficial in raising care standards generally, but we need to go further to protect the public and introduce a system of national regulation.
“This is particularly the case in the community, where care takes place behind closed doors, without the direct supervision of the qualified nurse who is ultimately responsible for the work of the healthcare support worker.”
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